Andrea Proctor was 31 with three children when she took her own life last year. At her inquest this week, her mother painted a grim picture of the help given to people suffering from mental illness in Ireland
ANDREA PROCTOR is a statistic now, but she was once a daughter, a mother and a wife. She was the second of Yvonne Byrne’s three children. “She was a happy child. A very quiet child. Very intelligent. She never played with toys. She used to pick things up and study them.” Proctor got six honours in her Leaving Cert. She became a civil servant, working for the Department of Defence. She took up tae kwon do and became very good at it. She got married. She had three children. Her youngest child turned two on July 6th, 2010. Andrea Proctor took an overdose of a variety of medication two and a half weeks later, on July 23rd. She was 31.
Byrne says the system failed not only her daughter but also her grandchildren. So she is pleased that the inquest into Proctor’s death was reconvened last Tuesday, specifically so that the health professionals whose care she was under could be called.
Proctor’s brother, Barry, postponed going to Australia with his new wife to attend the inquest. “It’s about how bad, how obviously bad, the health system is for someone who’s in trouble,” he says.
Proctor’s decline took place over eight months. Her mother first noticed something amiss with her in September 2009. “Prior to her daddy dying I noticed that a girl who was quite a quiet girl, never a talker, came here for coffee and we were chatting. And she chatted for five hours.” When Byrne pointed this out, her daughter uncharacteristically replied, “That’s just me, I’m real bubbly. I’m full of confidence.”
On November 9th, 2009, Proctor’s father died, and she had a breakdown. “She just crashed after the funeral. She just went totally off her head.” Six days later she was admitted for the first time to the acute unit of St Ita’s hospital in Portrane. She stayed for 10 days. Byrne visited her there.
“I cried when I went to St Ita’s with my sister. The best way I could describe it was I thought I’d walked into the pages of a Charles Dickens novel. My sister couldn’t stop crying. And we were trying to put a brave face on it. The best description I could give you of St Ita’s was dark, dirty, dank, dreary, disgusting, decrepit, dated, depressing. You name it. Unbelievable. I’ve never seen anything to equal it in my life. We cried leaving her there.”
According to Barry, “Andrea would say anything to get out of St Ita’s.” And staff at the hospital could not detain her, because she was a voluntary patient. But she knew she should be in hospital. “When she came out she’d say, ‘Mammy, I know I’m sick. I’ll go into any other place. Could you pretend that I live on the southside so I can go into John of God’s?’”
But if Proctor found the acute wing of St Ita’s unbearable, her mother is more worried about the communication between the social services and her family in the months before her daughter’s death.
IN THE CORONER'S COURTthis week, Andrea Proctor's mother spoke of the catastrophic failure of the health services. "I'm appalled by the record presented here," she said, speaking from the body of the court. "Nobody did anything for my daughter."
Throughout the hearing, Byrne questioned the actions of the social services in her daughter’s case. In one exchange, Maria O’Dwyer, a social worker with HSE Child Protection Services, said Proctor had a family-support worker assigned three days a week. It was not thought that there were any child-support issues, she said. A care worker had met with Proctor on three occasions, she said.
Byrne spoke aloud from the back of the court: “My stomach turns when I hear about this three days that the family-support worker was there. A baby is awake for 84 hours a week, and Andrea was getting help for a total of three hours per week. That lasted for three and a half weeks, until the youngest child got a place in creche for two hours per day.”
When O’Dwyer told the coroner there had been two home visits to Proctor by a care worker in July 2010, Byrne countered: “These visits were a direct result of my phone calls to you.” Both Byrne and Proctor’s husband, Stephen, told the coroner they had received no calls or messages from O’Dwyer.
Dr James O’Connor, a psychoanalytic psychotherapist at St Francis Day Hospital, in Dublin, told the court he had had 25 appointments with Andrea Proctor, at which she spoke about suicide.
At this point, Barry Byrne, Andrea’s brother, returned to a point frequently made by the family: the unforeseen consequences of patient confidentiality. “What breaks our hearts is that we did not know how bad she was,” he said.
Dr Martin Garland, consultant psychiatrist at St Ita’s in Portrane, said Proctor’s death had come “as a great surprise and shock to us”. On the subject of interaction with her family, he had to honour patient confidentiality at all times, he said.
“I couldn’t get access to you,” Yvonne Byrne told Garland. Doctors must talk to the families, she said. She understood about patient confidentiality, she said, but “I’m talking about a family only trying to give you information. At the moment the family can’t get access to say: ‘This is how this person was. Can you bring this person back?’ Surely that is in the interest of every person who is mentally ill. And to talk to the mothers, because their love is unconditional.”
She said she could have assisted Garland’s diagnosis of her daughter’s illness at a much earlier stage. “You gave the right diagnosis to Andrea just before she died, of premenstrual dysphoric disorder. But I could have told you that in November.” She also told Garland, “You said she was bipolar,” and, “The bipolar medication screwed her up big time.”
Garland said when Proctor was first admitted to St Ita’s, “She had all the classic hallmarks of hypomania, but in the course of time my diagnosis changed.” Proctor would have fallen under the rubric of “emotionally unstable”, he said. “The initial medication she was under was not unsuitable, although the diagnosis had changed. Lithium, for example, prescribed for bipolar disorders, is also a mood augmenter.”
The coroner returned an open verdict on Andrea Proctor’s death because, he said, although she took her life, it was not proved beyond doubt that suicide was intended.
Her suicide note was not dated. According to the garda who attended the scene, Kieran Devine, Proctor’s son, then 10, had found the suicide note under his mother’s pillow. The boy had found his mother semi-conscious at the kitchen table. He subsequently hid the suicide note in the garden, said Devine. “He didn’t want his mother to get into any trouble,” said Yvonne Byrne. But in the end he gave the suicide note his grandmother.
The coroner congratulated Proctor’s family on being proactive. It was obvious she had been greatly loved, he said. The four health professionals came to shake hands with Byrne and to offer their sympathies.
In a statement, the HSE offered “its deepest sympathy to the family of Ms Proctor on their tragic loss. For reasons of patient-client confidentiality the HSE will not comment on individual cases. Every patient in the care of the HSE is entitled to the reassurance that we will not comment on the particular circumstances of their case . .. without their consent.”
It “acknowledged that the Admission Units at St Ita’s Hospital are not suitable for the provision of a modern Mental Health Service. Consequently, a new purpose-built acute-admissions unit is being built at Beaumont Hospital. In the interim, it is planned to move from the existing premises to a refurbished unit in St Ita’s Hospital in September 2011.”
For Byrne, two questions remain, which she thinks many families who have a mentally ill relative will share. Firstly, why did her daughter come out of mental hospital worse than she went in? And secondly, why did no one within the health system speak to her daughter’s family, either to gain more information about her life and personality or to help her children, who were aged 10, six and two years old when she died?
I cried when I went to St Ita’s. The best way I could describe it was I thought I’d walked into the pages of a Charles Dickens novel
